Review of the anaesthetic management of 21 patients undergoing laparotomy for carcinoid syndrome

Veall, G R; Peacock, J. E.; Bax, N. D. S.; Reilly, CS

doi:10.1093/bja/72.3.335

Cited by 69 publications

(56 citation statements)

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“…1 , 2 The anesthetic management of patients with carcinoid syndrome has previously been reviewed. [3][4][5] However, the anesthetic management of liver transplantation for carcinoid tumour metastatic to the liver has not been reported. We present the successful management of one such case.…”

Section: Discussionmentioning

confidence: 99%

“…3 A total of 10 mg phentolamine iv was given to control hypertension. Subcutaneous and intravenous boluses of 50 µg octreotide were also injected.…”

Section: Discussionmentioning

confidence: 99%

“…5 Bronchospasm, hepatomegaly, and hyperglycemia are less common symptoms. 3,5 Orthotopic liver transplantation is a recent treatment option for patients with extensive hepatic carcinoid metastases and disabling symptoms. Although still controversial as an indication, liver transplantation appears to result in a prolonged disease-free interval and a longer survival, as well as in a considerable palliation of symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…The most important ones contributing to the carcinoid syndrome appear to be serotonin, histamine, and the kinin peptides. 3 In the past, anesthetic management has focused on blocking histamine and serotonin receptors and avoiding drugs facilitating the release of mediators from tumour cells. Drugs thought to trigger mediator release include the opioids meperidine and morphine, the neuromuscular relaxants atracurium and mivacurium, and the catecholamines, including medications which induce their release.…”

Section: Discussionmentioning

confidence: 99%

“…The use of thiopental has been discouraged by some because in vitro studies have demonstrated a dose dependent histamine release from skin mast cells. 3,4,11 However, thiopental triggered histamine release seems to be of minimal importance in the clinical setting. 1 1 The use of succinylcholine has also been discouraged because the increase in intra-abdominal pressure resulting from muscular fasciculations could potentially trigger mediator release.…”

Section: Discussionmentioning

confidence: 99%

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Orthotopic liver transplantation for carcinoid tumour metastatic to the liver: anesthetic management

Claure

Drover

Haddow

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To report the anesthetic management of a patient with carcinoid tumour metastatic to the liver who presented for orthotopic liver transplantation. Anesthetic implications of metastatic carcinoid tumour on liver transplantation and the use of octreotide are discussed.Clinical features: A 51-yr-old woman with intestinal carcinoid tumour metastatic to the liver presented for orthotopic liver transplantation, a recent treatment option for patients with extensive hepatic carcinoid metastases and disabling symptoms unresponsive to conventional therapy. Despite continuous administration of the somatostatin analogue octreotide via a hepatic artery infusate pump, the patient suffered from daily break through symptoms, which included flushing, palpitations, paroxysmal hypertension, and dyspnea. The patient presented to the operating room with sinus tachycardia and severe arterial hypertension. Octreotide and phentolamine were used to prevent further mediator release and to control the paroxysmal hypertension. Midazolam, fentanyl, thiopental, succinylcholine, vecuronium, and isoflurane were used to induce and maintain anesthesia safely. An intravenous octreotide infusion was initiated after induction and continued throughout the case. Infrequent and non-threatening peaks in arterial blood pressure were readily treated with small intravenous doses of vasoactive drugs and octreotide. No other manifestations of the carcinoid syndrome occurred. The patient had an uneventful recovery and was discharged on postoperative day #6. Conclusion:The patient safely underwent orthotopic liver transplantation for treatment of symptomatic carcinoid tumour metastatic to the liver. The anesthetic management followed recent recommendations favouring the use of octreotide to prevent patients from becoming symptomatic. Outlined dosing regimen for octreotide provided satisfactory hemodynamic stability.Objectif : Présenter le traitement anesthésique d'une patiente atteinte d'une tumeur carcinoïde, avec métastase au foie, admise pour une transplantation hépatique orthotopique. Les implications anesthésiques de la tumeur sur la transplantation du foie et l'usage d'octréotide sont étudiées. Éléments cliniques : Une femme de 51 ans souffrant d'une tumeur intestinale carcinoïde, avec métastase au foie, s'est présentée pour une transplantation du foie orthotopique, une nouvelle option thérapeutique pour les patients chez qui les métastases carcinoïdes du foie sont étendues et les symptômes invalidants ne sont pas éliminés par la thérapie traditionnelle. Malgré l'administration continue d'un analogue de la somatostatine, l'octréotide, au moyen d'une perfusion insérée dans l'artère hépatique, la patiente souffrait d'une poussée quotidienne de symptômes qui comprenaient des bouffées vasomotrices, des palpitations, de l'hypertension paroxystique et de la dyspnée. À son arrivée à la salle d'opération, la patiente présentait une tachycardie sinusale et une hypertension artérielle sévère. Conclusion : La patiente a subi en toute sécurité une transpla...

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Section: Discussionmentioning

confidence: 99%

“…3 A total of 10 mg phentolamine iv was given to control hypertension. Subcutaneous and intravenous boluses of 50 µg octreotide were also injected.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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